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President, Chairman or Authorized Representative, Specify: Typed or Print Name: Date: APPLICATION CHECKLIST Check items below acknowledging these online documents have been read. Project #1: Hotel-Motel Tax Test Project #2: Hotel-Motel Tax Test (if applicable) Terms of Request, initialed and completed Assurances REQUIRED DOCUMENTS: ONLY SUBMIT THE DOCUMENTS REQUESTED BELOW *Email the documents via the link provided. IF MAILED, please submit all documents in a manila folder. IRS legal name of organization on IRS letter of determination If applicable, "dba" registration from county or state "Active Status" from Secretary of State with valid current date IRS 990, OR an extension to file IRS 990, OR audited financial statements, OR balance sheet and statement of Income and Expenses for the most recently completed fiscal year AND statement of Non-requirement to file IRS 990 List of your Board Officers names, addresses, telephone numbers and scheduled meetings Organization Date
Funding Year: January 1 through December 31
*Asterisk denotes required information